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Emotional thinking and dementia

Mary Jordan explains how carers can cope with 'emotional thinking' as dementia progresses.

Caring for someone with dementia is stressful but some carers unintentionally make it much harder for themselves. It is hard to understand that the thinking of someone with dementia has changed radically and unless you adapt to this way of thinking life will always be a battle.

From early childhood we are constantly taught to use our powers of reason and logic. But someone who has dementia is losing the ability to use this kind of thinking. Their powers of reasoning and ability to understand the consequences of their and others actions are fading away. The part of the brain which expresses wants and emotions is still intact however and it is this emotional thinking which is expressed more and more as dementia progresses.

We should deal with this by understanding what is behind seemingly ‘illogical’ behaviour. When someone with dementia refuses to do something it is because they are afraid – they may not understand what is expected of them or may fear what will happen if they comply with a request. Carers need to address the fear by reassurance and understanding – think about how one would pick up and comfort a frightened child.. They should not try to use reason and logic.

Frequently carers tell me how they have gone to great lengths to ‘explain’ to the person with dementia why something needs to happen – attending a day centre for example or visiting the dentist. They find it hard to grasp that such explanations will not work. People with dementia lose their ability to understand why some things need to happen. They can only grasp that what is being suggested is something they fear or dislike.

If instead carers used the matter of fact behaviour they would adopt when, for example, ensuring a child gets ready for school, they would find life easier and less stressful. People with dementia find even every day activities difficult. It is far kinder to tell them kindly and firmly what is going to happen than to try to explain, ‘make them understand’ or get their agreement. They will feel more reassured by your confidence and calm then by confusing attempts to persuade them to comply.

All this advice is not supposed to mean that you ignore the wishes of the person with dementia nor that you should just ride roughshod over their feelings. Rather it means that you take account of the reduction in their reasoning abilities and avoid putting them under the extra stress of trying to understand complex situations. People with dementia are not children but it can be worth remembering how we manage the limited reasoning abilities of children. Sensible parents do not persuade their children that they need to go to school or have a bath because children do not have the reasoning powers to understand the future implications of not doing these things. Telling someone with dementia, calmly and non-aggressively, that something is going to happen can lift from them the stress of having to make a decision when they do not have the logical and reasoning abilities to do this.

Remember to offer reassurance and address the fears and frustrations that the person with dementia is experiencing. People with dementia are often acutely aware (although they may be unable to put this into words) of the reliance they have on their primary carer and this can be a source of annoyance to them. Calm firmness on the part of the carer and an underlying understanding of how the emotional mind is becoming dominant can ease difficult situations.

About Mary Jordan

Mary works for a national dementia charity and is an Associate Director of ELM (End of Life Management Ltd). She has had considerable experience of caring for elderly relatives and friends and worked in the NHS for 9 years. Earlier publications include books on Caring and on GP Practice Management, in addition to articles in nursing and social care journals and magazines. Mary has published her new book this month by Hammersmith Books called ‘The Essential Carer’s Guide to Dementia’ and each month she will offer practical advice on how to deal with dementia.